In paediatric anxiety, fluoxetine, CBT, their combination and every sequencing of them worked equally well

The edition in brief

The most useful finding today is a null one, and it hands the decision back to families. A pragmatic SMART trial randomised 316 young people with severe anxiety, high sociodemographic disadvantage and co-occurring diagnoses, to fluoxetine or CBT first, with re-randomisation at week 12 for non-remitters. Youth-reported SCARED scores fell 31.7% over 24 weeks. No initial treatment beat another — CBT held a non-significant advantage of 1.45 points. Among week-12 non-remitters, adding the second modality did not beat continuing monotherapy, a difference of -2.74 with an interval spanning zero. The authors' conclusion is that patients, families and clinicians have a genuine range of options and may optimise by preference. One subgroup finding deserves flagging rather than acting on: non-Hispanic White youths did better initiating and continuing fluoxetine, while racial and ethnic minority youths did better transitioning to combination therapy after week 12. In a trial with this many prespecified comparisons that is hypothesis-generating. DadBooster randomised 50 fathers with clinically diagnosed postnatal depression to internet-delivered CBT or waitlist. Depression scores fell 72% against 40%, an adjusted mean difference of -7.26 on DASS-21, with stress, parenting self-efficacy and negative automatic thoughts all improving. And a post-hoc analysis found six-monthly paliperidone palmitate produced numerically less weight gain than the three-monthly formulation, most visibly in 18 to 25-year-olds.